Day 4: First Operation - A Young Policeman with Severe Mitral Valve Disease

On Friday, October 26, Niloo Edwards, MD, head of the division of cardiothoracic surgery at UW Hospital and Clinics, joined a Wisconsin delegation that journeyed to the Dominican Republic, there to spend a week providing free cardiac surgery to indigent residents in Santiago.

During his stay, Dr. Edwards and other surgeons operated on 11 patients, survived hurricane conditions and gained a greater perspective on health care in Latin America. The following is Dr. Edwards' blog of Day 4 of his experience.Return to Dr. Edwards' Blog: Day 1

Day 4: October 29, 2007

At 6:30am, we meet in the hotel lobby. It is pouring rain: The tropical depression has been upgraded to a tropical storm. The hospital roof leaks and we have to walk through a curtain of water to enter the ICU; it is like walking through the shower at a public swimming pool. Now I understand why there are potted plants in the halls. They're used to catch the water streaming from the ceiling. But we are in good spirits and excited to finally get down to operating.

PHOTO (above): The hospital's hallway

My first operation is a young policeman with severe mitral valve disease. The defibrillator has arrived as promised, but now there is no oxygen or compressed air. The tanks are on the ground floor but the storm has knocked out the elevators and they cannot bring the tanks up the four flights of stairs. I recruit Captain America to help me carry the tanks up the stairs – Joel’s marine training should have some use. I am still wondering how I well mange fine motor skill work after carrying a 300lb tank up the stairs when I hear that they have managed to get the elevator working and we will have the remaining tanks in 15 minutes.

We finally have the patient asleep, prepared, draped and have already made the skin incision when we find out that the ACT machine is broken. This machine measures how well the blood is heparinized so it will not clot during the heart-lung bypass. Fortunately both Sean and Jake have been around long enough to remember when we would warm the blood under your arm and use a clock to time how long it takes for clot to form. Sean works as an ACT machine while Jake runs the heart-lung machine.

PHOTO (above): In the operating room

Dr. Fritz Riveron assists me with the operation and, remarkably, things go very smoothly. We run the water gauntlet and get the patient back to the ICU wet but otherwise doing well.

PHOTO (above): During surgery

Fritz's patient is a young woman with unstable angina. He get her chest open when her heart fibrillates. The defibrillator doesn't work. I scrub in to help and mechanically squeeze the heart until Fritz can get her on the heart-lung bypass machine. We finally get the defibrillator to work and he finishes her bypass operation and tries to separate from the heart –lung machine but she is still unstable.

We decide to do another bypass graft to the front of the heart, this seems to do the trick and she comes off the heart-lung machine without too much difficulty, although she is on a lot of medication to support her heart.

PHOTO (above): Operating on a young woman with unstable angina

I head upstairs to check on my patient and Annette meets me looking like a coalminer with a headlamp. Because of the storm the ICU has lost power at least six times. Each time the ventilator stopped working and Annette has had to hand ventilate the patient for ten to fifteen minutes until the power is restored. Fortunately she brought headlamp flashlights. These have been the most valuable equipment we have brought with us.

PHOTO (above): Our headlamps prove to be valuable equipment

My policeman looks great. His fellow officer puts a Bucky bear we brought in his arms and takes a photo for the precinct bulletin board.

PHOTO (above): The policeman and Bucky Badger

Another emotionally exhausting day, but we are happy - at least everyone is alive, and before we left, Fritz's patient woke up and is already coming down on some of her drips. Jody has the hardest job of all of us. He has to set up, scrub the operation then break down and wash the equipment, re-wrap and sterilize the instruments and pull all the equipment and suture for the next day. But he still finds time to come up and visit the patients. I think it is a reflection of how invested we all are in each of the patients.